Spatial pattern of HIV-1 mother-to-child-transmission in Madrid (Spain) from 1980 till now: demographic and socioeconomic factors

Palladino, Claudiaa,b,c; Bellón, Jose Maríaa; Perez-Hoyos, Santiagod; Resino, Rosaa; Guillén, Sarae; Garcia, Doloresa; Gurbindo, María Doloresf; Ramos, José Tomásg; de José, María Isabelh; Mellado, María Josefai; Muñoz-Fernández, María Ángelesa

AIDS:
doi: 10.1097/QAD.0b013e328310fa96
Epidemiology and social: CONCISE COMMUNICATIONS
Abstract

Objective: To evaluate any possible association between indicators of social inequalities and the geographical distribution of HIV-1 mother-to-child transmission (MTCT) cases in Madrid.

Methods: We carried out an observational survey of 224 HIV-1 vertically infected children born in 1980–2006 living in Madrid. We elaborated maps representing the prevalence of HIV-1 MTCT cases. We assessed the association between indicators of social inequalities and the spatial distribution of MTCT cases. Poisson univariate and multivariate analysis of risk factors for MTCT were performed.

Results: We identified core areas of transmission mainly in southern Madrid until 2006. The prevalence of MTCT cases was significantly correlated to the percentage of immigrants, illiterates, unemployed women and the income in 1996 and 2000/2001. The risk of MTCT increased in the periods up to 1996 compared with the calendar period 1980–1989, whereas the risk decreased in 1999–2006 [relative risk, 0.08; 95% confidence interval (CI), 0.03–0.18; P < 0.001]. The risk was especially high in the districts of Usera (absolute relative risk, 11.4; 95% CI, 2.6–49.5; P = 0.001), Puente de Vallecas (absolute relative risk, 14.0; 95% CI, 3.4–57.9; P < 0.001) and San Blas (absolute relative risk, 12.5; 95% CI, 2.9–53.6; P = 0.001). The percentage of illiterates was the indicator that explained the risk of MTCT (absolute relative risk, 1.07; 95% CI, 1.05–1.10; P = 0.001).

Conclusion: We observed a geographic heterogeneity of the HIV-1 vertical transmission with the highest prevalence in disadvantaged districts. What is described in the present review is the HIV-1 vertical transmission within a social context; this approach could be relevant in analysing the pattern of HIV-1 transmission in other Western cities or highlighting the distribution of other infectious diseases.

Author Information

aLaboratorio de Inmuno-Biología Molecular, Hospital General Universitario ‘Gregorio Marañón’, Madrid, Spain

bIstituto Pasteur, Fondazione Cenci-Bolognetti, Italy

cUniversità degli Studi di Roma ‘La Sapienza’, Rome, Italy

dUnitat d'Epidemiologia i Estadistica, Escola Valenciana d'Estudis per a la Salut, Valencia, Spain

eServicio de Infecciosas Pediátricas, Hospital Universitario Doce de Octubre, Spain

fSección Inmuno-Pediatría, Hospital Materno Infantil Gregorio Marañón, Spain

gServicio de Pediatría, Hospital Universitario de Getafe, Spain

hServicio Infecciosas Infantil, Hospital Universitario La Paz, Spain

iServicio de Pediatría, Hospital Universitario Carlos III, Madrid, Spain.

Received 18 April, 2008

Revised 16 June, 2008

Accepted 2 July, 2008

Correspondence to Dra. Ma Ángeles Muñoz-Fernández, Laboratorio Inmuno-Biología Molecular, Hospital General Universitario ‘Gregorio Marañón’, C/Doctor Esquerdo 46, 28007 Madrid, Spain. Tel: +34 91 586 8565; fax: +34 91 586 8018; e-mail: mmunoz.hgugm@salud.madrid.org

© 2008 Lippincott Williams & Wilkins, Inc.